An introduction

Hi There!
My name is Victoria Lindsay and I am a third year occupational therapy student at Otago Polytechnic. This blog has been created for an occupational therapy student conference that I will be participating called POSITIV_OT. This blog will provide a professional development opportunity for you, the reader, my peers and potential colleagues.  

The idea of this topic came about after my second year placement in stroke rehabilitation, where I experienced and facilitated several Wii games groups for patients who all had different deficits resulting from their stroke. Throughout my placement I was fascinated, and currently still am, how the brain recovers after significant damage and to whether Wii games would patients improve upper limb function. 

Being an occupational therapy student, and soon to be a new graduate, it is exciting to know that my skills, knowledge and abilities to provide interventions to patients, can improve a persons quality of life and occupational performance. 

I hope you all enjoy reading my blog and hopefully it will answer any questions that you have on this topic. 

Enjoy reading!

References

Physiofunction. (2013). Playing wii game. Retrieved from http://www.physiofunction.

co.uk/Uploads/Image/articles/OAPWii.jpg.

What are wii games and how can they help stroke patients?

Can you imagine having a stroke and having your world change in an instant?

Well that is the reality for some individuals in today’s society. Stroke is the fifth largest cause of disability in the world. Closer to home stroke is the third largest killer in New Zealand, that’s about 2500 people every year. Breaking that down further everyday about 24 New Zealanders have a stroke. A quarter occur in people under 65 years, Stroke Foundation of New Zealand, (2013).

A recent approach in rehabilitation for stroke patients is the use of Nintendo Wii games that are better known, as ‘WiiHab’, or 'Wii-Habilitation'. These are virtual reality Wii games that are played on a play station or a computer providing patients with a controlled, safe and individualized therapy that is multi-sensory, multidimensional and functional Saponsnik et al., (2010).

Based on my experience, during my second year placement there are different Wii games that occupational and physiotherapists can use in rehabilitation. In my first two weeks of placement I was fortunate to play some games such as, Ten Pin Bowling, and Cooking Mama against some patients to experience the competitive and interactive atmosphere in which patients thoroughly enjoy. Coincidentally this led on to me facilitating multiple individual and small group Wii sessions consisting of two to three patients from the ward. Occasionally the sessions consisted of more patients, in which my supervisor would help me to co-facilitate the group sessions.  
Wii games create a stimulated and fun environment for patients to develop a range of skills and learn task based techniques. 
 

Four common Wii games that occupational and physiotherapists use as interventions for improving upper limb function for stroke patients in rehabilitation are:

• Cooking Mama
• Tennis
• Standing Balance
• Ten Pin Bowling  

These Wii games involve a lot of upper limb hand movements to improve patient’s fine motor skills. Cooking Mama uses movements that replicate peeling an onion, cutting a potato and shredding cheese. 

Tennis involves upper limb movements to hit the ball over the net.
Standing Balance involves patients standing on a balance board that consists of four sensors to measure patients centre of balance, and weight distribution in standing.

Ten Pin Bowling involves upper limb movements using the hand controller to release the ball. 

Through my observations I strongly believe incorporating Wii games into physiotherapy and occupational therapy practice is beneficial to improving patients upper limb function of the affected limb. This has been further justified by studies from Saponsnik et al., (2010), that Wii games help patients to redevelop connections and long-term potentiation within the brain. These motor patterns are developed from repeated stimulation and task orientated training of the affected limb, ultimately leading to functional improvements after stroke.

References  

Sapsonik, G., Teasell, R., Mamdani, M., Hall, J., McIlroy, W., Cheung,

D.,Thorpe, K., Cohen, L., & Bayley, M. (2010). Effectiveness of virtual reality using wii gaming technology in stroke rehabilitation: A pilot randomized clinical trial and proof of principle. American Heart Association Journals, (41), 1477-1484. doi:10.1161/ STROKEAHA. 110584979

Stroke Foundation of New Zealand (2013). Facts about stroke in new

zealand. Retrieved from http://www.stroke.org.nz/node/16

Advantages and disadvantages of using wii technology

Stroke rehabilitation is rapidly evolving as there are many advantages and some disadvantages to using Wii games in rehabilitation. The duration and intensity of the rehabilitation strategy are important factors in it's effectiveness. A randomized control trial study showed using Wii gaming technology is effective in enhancing motor function following a stroke. 22 stroke survivors of mild to moderate ischemic or hemorrhagic strokes were randomized to play recreational games such as, cards and Jenga or Wii Tennis and Cooking Mama, over an intense two week period. Results found significant motor improvements in speed, fine and gross movements, grip strength de Souza, Paim, Imamura, & Marcon, (2011).
 

Advantages

•  Has a non-threatening game type feel to it
• Used with individuals or in a group setting, enabling both physical and cognitive perceptual skills to be addressed
• Positive theme- interactive, visual, goal led and provides sensory feedback
• Useful to involve patients with higher cognitive level functioning to work on focused and sustained attention
• Family interaction with patients, playing game
• Work in a virtual environment that is safe, fun, engaging and motivational for patients
• Repetitive tasks and specific activities- activate mirror neuron system involved in brain plasticity
• Physical strength and movement.

Deutsch et al., (2011) explains some of the disadvantages using Wii games in rehabilitation.
 

Disadvantages

• Not successful for patients who have had little or no experience and don’t know how to use a computer or play station
• May not see it as a valid treatment tool
• Patients may get offended by what the Wii is saying e.g ‘ you're not doing good enough’, or ‘you're unbalanced’
• Patients that are already depressed and have low mood, not a good mood enhancer
• Cognitive problems if patients can't follow instructions, have visual, language problems, can't express or receive information
• Patients need to be able to co-ordinate the remote if this is not achieved can lead to frustration
• Depending on the location it is hard to restrict who is in for example, the lounge and minimize distraction.

My experience facilitating Wii games occurred on placement. I believe this is a fantastic tool that occupational therapists use. There is strong evidence according to de Souza, Paim, Imamura, & Marcon, (2011), and Deutsch et al., (2011) supporting occupational therapists use of Wii games in rehabilitation. 

References  

De Souza, L., Paim, C., Imamura, M., & Alfieri, F. (2011). Use of interactive video game for stroke rehabilitation. Acta Fislatr, 18(4), 217-221. doi:10.5935/0104-7795.20110010

Deutsch, J., Brettler, A., Smith, C., Welsh, J., John, R., Guarrera-Bowlby, P., & Kafri, M. (2011). Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation. Stroke Rehabilitation, 18(6), 701-719. doi:10.131/tsr1806-701